Oral, head and neck cancers difficult but treatable

For Michelle Valois, it all began with a visit to her primary care physician after waking up one morning last fall feeling ill with a cold and noticing what she thought was a swollen gland.

For Priscilla Fortin, it was her hygienist who sent her to an ear, nose and throat physician after noticing a suspicious-looking bump on her tonsil.

They were diagnosed with what doctors refer to as oral, head and neck cancers and thus began their journey with one of the most complicated cancers whose treatments are some of the most debilitating for many patients. However, patients with cancers treated in the early stages may have little post-treatment disfigurement.

“When I was first diagnosed back in late 2010, I was shocked, almost numb, and I don’t think I really took it all in until after my treatment was completed last June,” said Valois, of the Florence section of Northampton.

“It was surreal, like it was happening to someone else and not me. I didn’t get all upset and emotional,” said Fortin, from Belchertown, about her diagnosis last year. “I guess I was just in denial or shock.”

Both Valois and Fortin are among the more than 50,000 Americans diagnosed with cancers that arise in the head or neck region – including the nasal cavity, sinuses, lips, mouth, thyroid glands, salivary glands, throat or larynx (voice box) – every year.

Fortunately, with early detection the disease is preventable and treatable, according to Dr. Wilson Mertens, medical director of Baystate Regional Cancer Program.

“Head and neck cancers are curable malignancies, but the degree to which a patient can be cured is dependent upon detecting these cancers in their earliest stages. Screenings may help detect cancer at its most curable stage, when patients will require the least medical intervention,” said Mertens in information provided by Baystate.

According to the National Institutes of Health, doctors can play a major role in helping to save lives by performing a simple head and neck examination during well-care visits, and by discussing prevention efforts with those especially at risk for developing head and neck cancers.

“As physicians, we need to educate the public about head and neck cancer and encourage them to get regular checkups and to eliminate high-risk habits like smoking,” said Dr. Barry Jacobs of Ear, Nose and Throat Surgeons of Western New England.

Tobacco, including dip and chewing tobacco, and excessive alcohol use are the most significant risk factors for head and neck cancers.

“Eighty-five percent of these cancers are linked to tobacco use. People who use both tobacco and alcohol have a 15-times greater risk for developing these cancers than people who use either one or the other,” Jacobs said.

While tobacco and alcohol users traditionally have been considered the populations at greatest risk for these cancers, oral cancer cases are on the rise in younger adults who do not smoke.

“While we see mostly adults ranging from the mid-40s to about 65 years of age, we have begun to see more cases in teens and younger adults who do not smoke,” said Dr. Daniel I. Plosky, of Ear, Nose and Throat Surgeons of Western New England, who specializes in adult and pediatric head and neck surgery.

“We have new research that tells us this recent development is due partly to exposure to the human papillomavirus (HPV), the same cancer-causing infection associated with cervical cancer. This is yet another reason why parents should strongly consider having their daughters and sons vaccinated with Gardasil to help prevent them from this infectious virus.”

Other risk factors include poor nutrition and oral hygiene, excessive exposure to the sun, gastroesophageal reflux disease (GERD), a weakened immune system, and some environmental/occupational inhalants such as exposure to asbestos, wood dust, paint fumes and other chemicals. Men and those over age 40 are also at greater risk.

There are a few visible signs associated with oral, head and neck cancers that require immediate attention, including:

A sore in your mouth that doesn’t heal or that increases in size

Persistent pain in your mouth

Lumps or white or red patches inside your mouth

Difficulty chewing or swallowing or moving your tongue

Soreness in your throat or feeling that something is caught in your throat

Changes in your voice

A lump in your neck

Pain around your teeth

Valois’ doctor ordered a chest X-ray and blood work, and a biopsy was recommended. When the results came back, the diagnosis was squamous cell carcinoma, which had spread from her tonsil where the cancer had originated. As for Fortin, when she was referred to Mertens at the Baystate Regional Cancer Program, the bump on her tonsil, which turned out to be cancer, was already a stage IV carcinoma, and had spread to the back of her tongue and lymph nodes in her neck.

Keith O'ConnorDr. Yunes and Priscilla Fortin with the mask she wore during her radiation treatments

“As in Michelle’s case, many head and neck cancers spread to the lymph nodes in the neck,” said radiation oncologist Dr. Michael Yunes, director of the Stereotactic Radiosurgery Program at Baystate Medical Center.

“And, like Priscilla, many of our oral, head and neck cancer patients are referred to us by dentists, oral surgeons, or ear, nose and throat physicians who have already done a biopsy before referring them to our cancer center. We collaborate closely with these doctors on the front lines, and because we have such good communication with them, the process of evaluation to determine the best treatment plan will have already begun by the time they arrive at our office.”

Surgery, radiation therapy and chemotherapy, or a combination of the three, are the most common treatments designed to cure or stop the spread of oral, head and neck cancers by killing and/or removing the cancerous cells. The best method of treatment is dependent on the stage of the cancer and the overall treatment plan can involve many different healthcare professionals.

“The most important consideration, besides cure, is minimizing side effects on normal tissues. If there are two ways to treat the cancer with an equal cure rate, but one allows the patient to continue to speak and eat, it makes sense to try that method first before sacrificing normal functions,” Yunes said.

Side effects during treatment or immediately following can include fatigue, pain, inflammation of the mucus membranes, skin irritation, dry mouth, difficulty swallowing and eating, maintaining weight and hydration, as well as decreased blood counts.

Late side effects, which can persist much longer after treatment, include dry mouth, thickness of the skin, swelling of the neck, ulcers on the mucus membranes, altered thyroid functions, and an altered sense of taste, smell, or hearing.

“I’m not going to deny that the treatments were pretty brutal, but I had a lot of help along the way from my healthcare team – the supportive care was tremendous. Also, I was lucky enough to have an 85 to 90 percent chance of full recovery, and knowing that my odds were so good at beating my cancer made it easier to go through the grueling treatments,” Valois said.

Valois suffered many of the side effects common for oral, head and neck cancer patients – she couldn’t talk for nearly a month or eat by mouth for almost four months, which required her to use a feeding tube to maintain her nutrition. She is now cancer-free.

Valois credited getting through much of the ordeal with her family to Dr. Lucinda Cassells, who is part of Baystate’s oral, head and neck cancer program and where, as a member of the division of hematology/oncology, she has a special interest in symptom management and supportive care. Cassells arranged for Valois’ 9-year-old daughter and twin 5-year-old boys to tour the D’Amour Center.

“Ideally, we want to meet with patients prior to beginning their treatment plan so there are no surprises, so that that they know exactly what to expect, including the many side effects they will encounter along the way. Our goal is to take care of any problems that might arise during treatment and manage them without interrupting their treatment or stopping it altogether,” Cassells said.

“Oral, head and neck cancer is a socially isolating illness that can have a major impact on your quality of life. Patients have a long road ahead of them and are very unwell for quite some time, often being out of work for as much as four to six months. They come to us with a deep desire to get through this chapter of their life successfully. They want to know if they will get better, and it is our job to see that they do.”

Now cancer-free, and despite the challenges of some side effects, Fortin said she was “just happy to see another birthday.”

“You know, when you get to be 72, you don’t want any parties, but I was happy to make it, and it was the first time that I was really glad to see another birthday,” she said.

Yunes noted that “People treated for oral and oropharyngeal cancers are at risk for recurrence and a greater risk for developing secondary cancers. They must be monitored closely after treatment as part of their survivorship plan.”

The follow-up schedule is more rigorous than for many other cancer patients. Patients will be seen monthly for the first year and will continue to see their radiation oncologist for at least three years. They continue to be seen regularly for at least five years by their ear, nose and throat physician.